If you get your health insurance through your employer, you may find recent news from the Congressional
Budget Office unsettling. CBO is now projecting that 20 million American workers will lose their employer-provided health insurance this year. Faced with escalating health care costs (they went up 9% in the past year), many employers are choosing to drop the benefit altogether. Should you suddenly find yourself in the market for private health insurance, here’s what you need to know.
You will have many choices but they basically break down to managed care or indemnity plans. Indemnity plans give you the most flexibility in selecting doctors without referrals and using whatever hospital you want. But expect to pay for the privilege. You’ll usually have to meet your annual deductible before your
insurer pays anything on your claims. Once the deductible is met, your insurer will pay a set percentage of whatever is considered to be the usual and customary rate for a particular service. You pick up the balance. Often, you’re expected to pay upfront and submit a claim for reimbursement.
Managed care plans, which include HMOs and PPOs, tend to be more restrictive, often requiring that you use a primary care provider as a gatekeeper to specialist services and use only in-network providers. This keeps their costs lower and the savings are passed onto you in the form of lower premiums and lower out-of-pocket costs. If freedom of choice and flexibility are more important to you than saving money, you’ll probably be happier with a traditional indemnity-style program.
If you’re married, you’ll want to research whether it’s cheaper to purchase one plan for you and your spouse or individual plans for each of you.
If you have a doctor or specialist that you really like, make sure he or she accepts the individual health care plan you’re considering.
Don’t buy more health care coverage than you need. While many states have long lists of mandated care for group plans, individual health plans don’t necessarily have to include them. If you’re a post-menopausal woman, you don’t need maternity coverage, in vitro fertilization or other pricey options. Shop around and
choose a plan that meets your basic needs.
Consider a high-deductible plan coupled to a Health Savings Account. This lets you put pre-tax dollars in a special interest-bearing savings account that you can draw on without penalty for qualifying medical bills.
Shop around and compare quotes to get the best coverage for you. You can shop for individual health insurance quotes at einsurance.com.